Research Update

Do Fruits And Vegetables Help You Live Longer?

The Study

In a Swedish Cohort study, 71,706 men and women aged 45-83 were followed for 13 years to examine the effect of fruit and vegetable consumption on mortality. When compared to subjects consuming 5 servings of fruits and vegetables per day, subjects who never ate fruits and vegetables lived 3 years shorter and had a 53% increased risk of mortality. The authors believed the difference in mortality was due to the fruit and vegetable consumer’s lower rates of cardiovascular disease and cancer. American Journal of Clinical Nutrition 2013; 98:454-9.

Take Home Message

Fruits and vegetables are the healthiest things you can eat, aim for a minimum of 5 servings per day, more is better.

 

Do Nuts Make You Fat?

The Study

Although nuts are an extremely healthy food, many avoid them because they fear their high fat content will cause weight gain. A recently published meta-analysis examined this question. Thirty-three randomized controlled trials were included in this meta-analysis. The results were very interesting. When comparing diets that included nuts to diets that did not, researchers found no increases in body weight, BMI, or waist circumference. In fact, all three were lower in the nut groups, although these differences did not reach statistical significance. The authors believed that the protein and fiber in nuts increase satiety, and that is why they were not associated with weight gain. American Journal of Clinical Nutrition 2013; 97:1346-55.

Take Home Message

Nuts are an awesome food. They are high in healthy fats, protein, fiber, minerals, and phytochemicals. Feel free to include nuts in your diet without fear of them tipping the scale in the wrong direction. Just be reasonable with your portions.

 

 

What Should I Weigh?

When I meet a new weight loss client, one of the first questions I ask is, “How much weight would you ideally like to lose?” Usually they turn around and ask me, “Well, how much do I need to lose?”

My primary goal is to get my clients down to a point where their weight will no longer increase their risk of chronic diseases like heart disease, stroke, type 2 diabetes, and cancer. A simple and powerful measure of how your weight will affect your risk of disease is the Body Mass Index.

Your body mass index is your weight in kilograms divided by your height in meters squared. If your body mass index is 25 or lower, your weight is considered normal. If it falls between 25.1 and 29.9, you are considered overweight. If it is 30 or more, you are considered obese.

Risk of chronic disease begins to increase with BMI’s over 25 and rises sharply with BMI’s over 30. I always have my clients shoot for a BMI under 25. While the BMI measure isn’t perfect, there is a ton of solid research behind the numbers, so I always have my clients start there.  

The Center for Disease Control has a free BMI calculator (click here). You can use this calculator to figure out your BMI today and also what weight you need to reach to get it under 25. There are also a variety of BMI calculator apps for your Smartphone. Just go to your app store and type in “BMI calculator” and you’ll get a number of options to download, many of which are free.

 

 

 

 

 

Research Update: High Glycemic Carbs And Your Brain

Effects of dietary glycemic index on brain regions related to reward and craving in men. American Journal of Clinical Nutrition 2013; 98(3):641-47.

Objective

The goal of this investigation was to examine the effect of glycemic index on brain function during the late post-prandial period (4-5 hours after eating a meal).

Methods

Twelve overweight men consumed two liquid meals on separate occasions. The meals were identical in calories, macronutrients, and palatability. The only difference between the meals was that one had a glycemic index of 84, and the other had a GI of 37. Brain activity was then measured by MRI four hours after consumption of each meal. Blood glucose, insulin, and hunger were also measured repeatedly during the post-prandial period.

Results

Plasma glucose was significantly lower and hunger was significantly greater four hours after the high glycemic meal when compared to the low glycemic meal. The high glycemic preload also elicited a greater brain activity centered in the right nucleus accumbens. This area of the brain is associated with reward and food craving.

Comment

This is a fascinating study! We’ve known for years that high glycemic carbs promote a post-prandial dip in blood sugar that leads to an increase in hunger. I always thought that this was governed solely by the endocrine system. This is the first study to show that high glycemic carbs actually change brain activity, particularly in areas that control reward and craving. While this is just one study, it was very well designed.

Take Home Message

If you work with me or have read my books, you know that a low glycemic approach is the key to losing weight and improving health. This study provides even more reason to strictly limit high glycemic carbs like bread, pasta, white rice and sugar. Instead, focus on lower glycemic carbs like fruits, vegetables, legumes, and whole grains.

 

Should eggs be a part of your regular diet?

The controversy surrounding the egg is a great example of the divide between popular opinion and well-designed research in the field of nutrition. Eggs have been vilified for decades because of their high cholesterol content. Many doctors and nutritionists advocate complete avoidance of egg yolks. I recently read a well written review of the current literature on eggs and health in The American Journal of Clinical Nutrition (1). I definitely learned a few new things.  Therefore, I thought that an update on the research concerning eggs and our health would be a great feature article for the 1^st edition of this newsletter.

Why Have Eggs Been Vilified?

Eggs are considered unhealthy for one basic reason: they are high in cholesterol. A single egg has 213 milligrams. The daily recommended intake for dietary cholesterol is 300 mg. per day. Therefore, by consuming 2 eggs at breakfast, you exceed your daily recommendation for cholesterol. The theory behind the advice to avoid eggs is that consuming too much dietary cholesterol will increase risk of heart disease and stroke.

Research On Eggs And Disease

The article I mentioned earlier is a comprehensive review and meta-analysis of all research to date on the association between eggs and our health (1). In a meta-analysis, researchers combine data from many different studies in order to calculate a statistical summary of all published research. It is kind of like dumping all of the subjects from all of the studies into one population and then analyzing the data.

When this was done for eggs, the researchers found no increased risk of heart disease, stroke, or total cardiovascular disease when comparing those consuming one or more eggs per day to those eating less than one egg per week. This is not new or surprising. Past research has shown that dietary cholesterol is only weakly associated with serum cholesterol. In the Nurses’ Health Study, the Health Professional Follow-up Study, and the Framingham Heart Study, there was no association between egg consumption and risk of heart disease (2,3).

However, the meta-analysis found a 42% increased risk of type 2 diabetes when comparing those consuming one or more eggs per day to those consuming less than one egg per week. This was news to me and I found it a bit disturbing. Therefore, I went out and retrieved all of the major studies on eggs and type 2 diabetes and read them for myself.

I found 5 studies, 3 prospective cohort studies (4-6) and 2 randomized controlled trials (7,8). One of the prospective cohort studies showed a 58% increased risk of type 2 diabetes when comparing subjects consuming 1 or more eggs per day to those consuming less than one egg per week (4). The other 2 cohort studies showed no association (5,6).

The 2 randomized trials were of similar design and were conducted by the same research group (7,8). These trials found that consuming 3 eggs per day for 12 weeks did not raise fasting glucose or insulin resistance.

After reviewing the studies, I came to the conclusion that there is far more evidence that eggs do not increase the risk of type 2 diabetes than that they do. However, the study that showed an association was well designed, so we will keep our eyes on this area of investigation.

What Else Is In Eggs Besides Cholesterol?

An egg yolk is very much like a multivitamin supplement. It contains vitamin D, folate, vitamin E, vitamin A, monounsaturated fat, vitamin B12, vitamin B2, essential amino acids, linoleic acid, calcium, and vitamin B1. Egg yolks are, in fact, one of the most nutrient dense foods that you can eat.

Recommendation

I tell my clients to enjoy up to 6 egg yolks per week. This amount does not have any negative impact on cardiovascular disease and will absolutely pack their breakfast with protein and essential nutrients. There are 2 populations that I would alter this recommendation for:

1) Diabetics: There is evidence of an increased risk of heart disease in diabetics that consumed 1 egg per day (2). Therefore, if you are diabetic, I would limit egg yolks to 3 per week.

2) Older men with a diagnosis of prostate cancer: There is some preliminary evidence of an association between consuming 6 or more eggs per week and an increased risk of progression from more benign prostate cancer to a more deadly form (9). There is no evidence of this association for men consuming up to 3 yolks per week. While this area of research is not yet definitive, I’d play it safe and limit myself to 3 eggs per week if I was diagnosed with prostate cancer.

References

1) Shin, et al. Egg consumption in relation to risk of cardiovascular disease and diabetes: A systematic review and meta-analysis. American Journal of Clinical Nutrition 2013; 98:146-59.

2) Hu, et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women. Journal of the American Medical Association 1999; 281:1387-94.

3) Daubes, et al. Eggs, serum cholesterol and coronary heart disease. American Journal of Clinical Nutrition 1982; 36:617-25.

4) Djousse, et al. Egg consumption and risk of type 2 diabetes in men and women. Diabetes Care 2009; 32:295-300.

5) Djousse, et al. Egg consumption and risk of type 2 diabetes in older adults. American Journal of Clinical Nutrition 2010; 92:422-27.

6) Vang, et al. Meats, processed meats, obesity, weight gain and occurrence of diabetes among adults: Findings from Advent Health Studies. Annals of Nutrition and Metabolism 2008; 52:96-104.

7) Mutungi, et al. Dietary cholesterol from eggs increases plasma HDL cholesterol in overweight men consuming a carbohydrate restricted diet. Journal of Nutrition 2008; 138:272-76.

8) Ratliff, et al. Carbohydrate restriction reduces insulin resistance and plasma leptin without modifying appetite hormones in adult men. Nutrition Research 2009; 29:262-68.

9) Richman, et al. Intake of meat, fish, poultry, and eggs and risk of prostate cancer progression. American Journal of Clinical Nutrition 2010; 91:712-21.

New Newsletter

The science of nutrition is young and evolving. The tools to study the associations between our diet and our health are only a few decades old.  We have learned much, but clearly we have a way to go. High quality research is being published monthly that calls into question many of our older ideas about diet and disease. In order to help keep my clients on top of this research, I have decided to create a free newsletter delivered directly to their email address.

The newsletter will be published every 2 months and will provide valuable information on weight loss, nutrition, exercise, and preventative health.  Content will include: feature articles, research updates, book reviews, product reviews, questions and answers, and much more.

I strongly believe in permission based communications.  If you sign up for the newsletter, be rest assured that I will never share or sell your email address to anyone for any reason. You will also have the ability to opt out anytime you like.

If you are interested in signing up for this free newsletter, just click this link: www.drtomhalton.com/newsletter.html  and enter your name and email address.

Here’s to your good health!
Dr. Thomas L. Halton

Questions and Answers: Resistance Training

No matter what your health and fitness goals may be, resistance training, also known as weight lifting, needs to be a part of your program.  It has always surprised me how many people completely ignore this mode of exercise. I believe that this is mostly due to a variety of myths and misconceptions about strength training.  I thought I’d use this post to answer some of my most commonly asked questions about resistance training. Remember, always meet with your doctor to get clearance before starting any new exercise program.

1) I’m trying to lose weight, so I don’t need resistance training, right?

Wrong! Resistance training is a pivotal component of the weight loss process.  There are two reasons why this is so: 1) Once we hit our 25^th birthday, we start to lose muscle mass at the rate of 1% each year as a natural part of the aging process.  This is a problem because every pound of muscle burns roughly 50 calories per day.  So as you age, you are burning fewer and fewer calories each year.  The result is that it is much easier to gain weight.  Weight lifting stops this loss of muscle and can even add to your muscle mass so you burn more calories each and every day, just by breathing.

2) The second reason why weight training is so important has to do with our body’s natural defense mechanisms to weight loss.  When you lose weight without strength training, your body will let a little fat go, and then starts to freak out.  The human body does not consider low body fat a good situation since we evolved in times of food scarcity and famine.  So, it starts to preserve your body fat and burn muscle instead.  It is estimated that weight loss without strength training results in 50% fat loss and 50% muscle loss.  Over time, this will lower your metabolism and make it all but impossible to keep the weight off.  If you add weight training to your weight loss program, you’ll lose virtually 100% fat and keep your metabolism revved up.

2) Won’t I bulk up and become muscle bound if I lift weights?

 

Not at all.  There are different ways to lift weights.  Lifting heavy weights will result in muscle growth and you will notice that you are getting thicker.  However, using lighter weights with higher repetitions will result in lean and toned looking muscle without a noticeable increase in muscle size.  Most of my female clients want this result so I design their programs accordingly.  Some of my male clients want to get bigger and I can certainly help them do that.  Do realize that getting large bulky muscles is not automatically a result of lifting weights.

3) I’m too old for this sort of exercise, right?

Wrong! You can build muscle until the day you die, no matter how old you are.  I have clients in their 80’s who lift weights and enjoy a much higher level of functionality than their peers as a result.

4) How often should I work out?

The goal is three whole body workouts per week, but you can get away with two.  Do not work out two days in a row.  Try to separate your training sessions by at least a day (IE, Monday, Wednesday, Friday or Tuesday, Thursday, Saturday).  Your muscles need time to recover after a workout.

5) What equipment do I need?

If you want to join a gym and use all the fancy machines, feel free to!  I love working out at nice gyms and did so for years.  As I’ve gotten older and much busier with my business, I strongly prefer working out at home.  It is a real time saver.  Women basically just need a few pairs of dumbbells and an exercise mat to get a great workout.  Men generally need a little bit more weight but can get an inexpensive weight set and a basic bench for a small investment.  If you are interested in learning more about equipment for your home gym, check out this older post here.

 

 

 

 

Research Update: Protein Consumption and Subsequent Energy Intake

Protein leverage affects energy intakes of high protein diets in humans. American Journal of Clinical Nutrition 2013; 97:86-93.

Objective: To examine the association between protein consumption and subsequent energy intake.

Methods: This study was a 12 day randomized crossover trial of 40 men and 39 women.  Subjects visited a university cafeteria for breakfast, lunch, and dinner. The foods offered were similar for each of the three 12 day intervention periods, but varied in protein content (5% of calories, 15% of calories, and 30% of calories).  Fat was kept constant at 35% of calories, so the protein was substituted for carbohydrate.  Subjects could eat as much at a meal as they wanted.

The researchers measured total daily caloric consumption for each subject when they were eating low, moderate, and high amounts of protein.  They also measured subjective ratings of hunger and satiety in each of these three conditions.

Results: The results were striking.  When the subjects were eating 5% of calories as protein, they averaged 2,228 calories per day.  When they were eating 15% of calories as protein, they averaged 2,298 calories per day.  When they were eating 30% of calories as protein, they averaged only 1,722 calories per day!  Fluctuations in hunger and desire to eat were attenuated in the high protein group as well.

Discussion: This is a beautifully designed study.  I love crossover trials, because you are using the same subjects for each of the conditions being tested, which all but eliminates sampling error.  The difference between the moderate and high protein groups was 576 calories per day.  This is a dramatic difference that would have a major impact on body weight. 

The research is really beginning to mount on how dietary protein promotes satiety and decreases subsequent energy intake.  The mechanisms aren’t quite clear, but it may have to do with the high nitrogen content of protein foods.  Nitrogen is difficult for our body to process ,so the theory is that when we eat a lot of protein, our body shuts down hunger in order to prevent nitrogen levels from getting too high.

Take Home Message:  If you are looking to lose weight and decrease your hunger throughout the day, add a bit more protein to each meal.  I have my clients shoot for 20-25% of total calories as protein.  I have found this level to be safe and highly effective for weight loss.

Book Review: Fat Chance

Fat Chance is next up for review. The author, Dr. Robert Lustig, is a medical doctor and the Director of the University of California San Francisco Weight Assessment For Teen And Child Health Program.  You may remember him from his Youtube video, “Sugar: The Bitter Truth”, which was viewed over 3 million times.

Introduction

The basic premise of Fat Chance is that a calorie is not always a calorie.  In other words, there are hormonal consequences to the foods we eat that tend to promote fat storage or fat burning.  The book cites our increased sugar consumption as the driving force behind the obesity epidemic.  The book focuses a lot on the hormonal consequences of our food, how these hormones influence our health, ways to change our diet to improve our health, as well as a section on public health policy solutions to the obesity epidemic.  The book was extremely well written and well referenced.  I really enjoyed reading it and learned a lot.

Five Things I Really Liked About Fat Chance

1) The idea that a calorie is not necessarily a calorie.  For years, the prevailing wisdom was that if you burn more calories than you take in, you’ll lose weight, no matter what you eat.  We are now learning that this is not always true.  Certain foods start a hormonal sequence that actually promotes fat storage while other foods do not.  The book nicely explains this.

2) The section on the hormonal consequences of our food.  This was very well done.  Lustig explains what happens biochemically when we eat different types of fat, protein, and carbohydrate foods. This knowledge is absolutely essential if you want to lose weight.

3) The toxicity of sugar.  If you work with me or read any of my books, you know how I feel about sugar.  After trans fat, I believe it is the worst thing you can eat. The section on sugar nicely explains why this is so.

4) The section on visceral vs. subcutaneous fat.  This was a great explanation of the difference between these 2 types of fat.  All body fat is not created equal!  Visceral fat (found inside the abdomen and organs) is far more damaging to our health than subcutaneous.

5) His proposed policy changes to control the obesity epidemic. This section is definitely a bit controversial.  Policies such as soda taxes, placing limits on advertising for unhealthy foods, and banning sugar in schools tend to raise as many political conversations as public health conversations.  However, this section brings up some pretty interesting ways to help curb the obesity epidemic and I found it a very interesting read.

Five Things I Didn’t Agree With In Fat Chance
1) Lustig repeatedly mentions that weight loss through diet and exercise is impossible to maintain long term.  I couldn’t disagree more.  With the right combination of diet, cardiovascular exercise and resistance training, long term weight loss is absolutely possible.  I’ve seen it hundreds of times with my own clients over the past 15 years.  Just because it is not easy and most people don’t know what to do, does not mean that it is impossible.

2) Lustig goes on to mention that being a little overweight is actually good for your health. He cites studies that found those with a BMI between 25 and 30 have the longest life span.  These studies were methodologically flawed by including smokers and sick subjects.  Since most diseases cause weight loss before death, and because smokers are thinner and ultimately less healthy than non-smokers, including these subjects in statistical analyses makes it look like thin people are less healthy.  In the Harvard cohorts, when these methodological flaws were controlled for, there was strong evidence that being overweight significantly increased risk of disease and early death.

3) Lustig didn’t really go over what you should eat to lose weight and be healthy.  There were no sample meal plans, just a shopping list.  I thought there could have been a bit more guidance here.

4) That leads me to the shopping lists.  Lustig spends most of the book explaining the hormonal consequences of eating too much sugar.  He is so right, and this was my favorite part of the book. However, I was a bit confused when he presented his shopping guide.  Foods were divided into 3 categories: 1) Green light foods can be eaten anytime.  2) Yellow light foods can be eaten 3-5 times a week. 3) Red light foods can be eaten once per week.  There were a lot of high sugar yellow light foods!  For example, a bunch of high sugar breakfast cereals were in the yellow category.  Some had up to 19 grams of sugar per serving, which is almost 5 teaspoons.  These were allowed up to 5 times per week.  This amount of sugar will increase hunger and cravings for more sugar.  I’ve found 100% sugar avoidance is the only way to go.  If you have a little sugar every day, you’ll want more and never get over your cravings.

5) Very little mention of resistance training.  In my opinion, building calorie burning muscle through resistance training is an essential component of long term weight loss.  Fat chance didn’t really spend any time on this at all.

Is Fat Chance Worth Reading?

Absolutely!  This book is a must read for anyone concerned about how our diet affects our weight and our health, which should be all of us!  Dr Lustig is a smart guy who is passionate about reducing the suffering caused by the obesity epidemic.  Just about anyone who reads this book will think twice next time they are in front of a cookie or brownie.  Life without sugar is admittedly very difficult at first, but after a couple of weeks you truly won’t miss it and your health will improve in ways you won’t believe.

Product Review: Nike Fuel Band

The ability to measure your progress toward a fitness goal is pivotal.  Today, I’ll review a product that can help you do this in a big way; the Nike Fuel Band.

The Nike Fuel Band is a tiny device that you wear around your wrist like a watch.  It contains a sports tested accelerometer that measures your physical activity.  It gives you a number of useful measures: including the number of steps you walk per day, the number of calories you have burned from physical activity, and most importantly, your Nike Fuel for that day. 

Nike Fuel is a universal metric of physical activity.  You set a goal for Nike Fuel points in a day, mine is 3000.  Your Fuel Band converts all of your physical activity into Nike Fuel points, including walking, running, weight lifting, basketball, and all other sports and activities.  The band has a series of LED light that turn from red to yellow and then to green as you progress toward your Nike Fuel goal for the day.  When you hit your goal, it lets you know.

Pros
1) This device measures all of your physical activity, not just your steps. This gives you a much better idea of your total activity.

2) You wear the Fuel Band like a watch.  This is a huge upgrade over most pedometers that you have to clip onto your belt.  I can’t tell you how many of my clients have lost their pedometer because it has fallen off of their waist at some point in the day.  In most cases, it is never found.

3) The Fuel Band plugs directly into your computer’s USB port to recharge and upload data.

4) You have free access to the Nike Fuel website, which keeps track of your activity and allows you to set goals.  The website is awesome.

5) Very good battery life.  In my experience, it lasts 5 or more days without a charge and once plugged in, recharges very quickly. 

6) It can store multiple day’s worth of data and then uploads automatically while charging.  Therefore, you don’t have to connect it to your computer every day.  Just charge it every week or so and your data will be uploaded.

7) It also tells the time.

Cons

1) The only con I can think of is that at $150, it is a bit more expensive than some of the other products on the market.

Would I Recommend the Nike Fuel Band?

Absolutely! Many of my clients have picked one up and they all love it as much as I do.  It will teach you a ton about your activity level.  You start to understand your patterns of physical activity.  You’ll be able to see which days of the week you consistently hit your goals, and which days you don’t.  When you come up with a plan to improve on the days that you miss, you can easily measure your progress.

It is very motivating as well.  I set a goal of 100 days of 3000 fuel points, which I’m proud to say that I hit! More than once, I was doing a few minutes of jumping jacks before I went to bed to make sure I hit my goal for the day.  My wife thought I was nuts, but once I set that goal; I wouldn’t go to bed until I hit it.

For my weight loss clients, I have them set a goal of 3000 Fuel points and 10,000 steps per day.

The Nike Fuel Band retails for $150 and you can pick it up on the Nike.com website.

Click here for more information or to pick one up.

Research Update: Mediterranean Diet and Cardiovascular Disease

Primary prevention of cardiovascular disease with a Mediterranean diet. New England Journal of Medicine 2013 DOI: 10.1056/NEJMoa1200303

Objective:  The objective of this trial was to compare the effects of a Mediterranean diet and a low fat diet on risk of cardiovascular disease in subjects over 5 years.

Methods: 7,447 subjects at high risk of developing cardiovascular disease were randomized into one of 3 diet groups: A Mediterranean diet supplemented with olive oil, a Mediterranean diet supplemented with nuts, and a low fat diet. The subjects were followed for 4.8 years and the primary endpoints were myocardial infarction, stroke, or death from cardiovascular causes.

Results: The Mediterranean group supplemented with nuts had a 30% lower risk of cardiovascular disease when compared to the low fat group.  The Mediterranean group supplemented with olive oil had a 28% lower risk of cardiovascular disease when compared to the low fat group.  The trial was stopped early because it was no longer considered ethical to keep the low fat group on a diet that could be increasing their risk of cardiovascular disease.

Discussion: This is a beautifully designed study in an elite research journal.  A 30% reduction in risk of cardiovascular disease in only 5 years is an impressive difference.  The authors believed that the benefit of the Mediterranean diet was due to favorable changes in blood lipids, insulin sensitivity, and resistance to oxidation, inflammation, and vasoreactivity.

Take Home Message:  This study provides further evidence that a low fat diet is not the way to go.  In fact, this study is so big and so well done, that it very well may be the final nail in the coffin for low fat diet proponents.  If you want to reduce your risk of cardiovascular disease, the number one killer in the U.S., follow a Mediterranean approach; which features olive oil, nuts, fruits and vegetables, legumes, lean protein and limits sugar sweetened beverages, breads, sweets, butter, and red meat.

Top 10 Sources Of Hidden Sugar In The American Diet

In my opinion, sugar is the most serious problem with the American diet. As a nation, we consume a ton of it!  It has been shown in the research literature to increase the risk of obesity, heart disease, and type 2 diabetes.  What makes sugar so dangerous is its addictive quality.  The more you have, the more you want.  It is very hard to do sugar part time.  In 15 years of working with clients, I have found that the only way to deal with sugar is to avoid it 100%.  Once you are off of it for a period of 2 weeks, you honestly won’t even miss it.  But if you have it now and again, your cravings for it will be a daily battle.

Most sources of sugar are quite obvious to my clients: soda, cookies, cake, ice cream, etc.  However, there are a lot of hidden sources of sugar in the American diet.  I thought I’d use this post to list out the top 10.

10) Barbecue Sauce: Most brands have 2½ teaspoons of sugar in a 2 tablespoon serving. Many have even more than this.

 

9) Jelly And Jam: A 2 tablespoon serving provides a startling 6½ teaspoons of sugar.

8) Energy Bars: These are marketed as healthy, workout friendly snacks or meal replacements, but in most cases they are nutritionally equivalent to candy bars.  Most leading brands have over 6 teaspoons of sugar per bar.

7) Dried Fruit: Long considered healthy, raisins and other dried fruits are a huge source of hidden sugar in our diets.  A quarter cup serving of raisins has 7½ teaspoons of sugar.

6) Ketchup: A 2 tablespoon serving has 2 teaspoons of sugar. 

5) Low Fat Salad Dressing: When manufacturers reduce the fat in a product, they almost always add more sugar to improve the taste.  Most commercial low fat dressings pack 1½ to 2 teaspoons of sugar in a 2 tablespoon portion.  Since most people use more than this to dress their salad, the sugar can add up fast.

4) Vegetable Juice: When you separate the fiber from the sugar in a fruit or vegetable, you are left with a very high glycemic load beverage.  There are almost 2 teaspoons of sugar in an 8 oz glass of tomato-based vegetable juice.

3) Flavored Yogurts: These are perceived as a healthy choice for breakfast or for a high protein snack.  However, the typical flavored yogurt has 3¼ teaspoons of added sugars in a 6 ounce serving.

2) Balsamic Vinegar: This one is usually a shocker to my clients.  Balsamic vinegar can have a ton of sugar.  It really depends on the brand.  Check your labels.  I’ve seen balsamic vinegar that has 5 teaspoons of sugar in a 2 tablespoon serving! Make sure the one you use has a lot less.

1) Orange Juice: Long considered a healthy start to your day, orange juice is loaded with sugar.  While it is naturally occurring sugar, it is separated from the fiber in the orange, so it's impact on your blood sugar is dramatic.  You’ll find 5½ teaspoons of sugar in a typical 8 ounce glass of orange juice.

Feature Article: New Research On Diet Soda

Consumption of artificial sweetener and sugar containing soda and risk of lymphoma and leukemia in men and women. 
American Journal of Clinical Nutrition 2012; 96:1419-28.

Last month, a very interesting article was published examining diet soda consumption and risk of certain cancers.  The results were a bit surprising and a bit disturbing.  I thought I’d use this post to explain the ramifications of this investigation. 

Summary Of Findings

The objective of this study was to examine the association between diet soda consumption and risk of 3 cancers: non-Hodgkin’s lymphoma, multiple myeloma, and leukemia.  The study included 47,810 men from the Health Professional Follow-up Study and 77,218 women from the Nurses’ Health Study.  Participants were followed for 22 years.  Here are the main findings:

-When the 2 cohorts were combined, there was no significant association between diet soda consumption and risk of these cancers.

-Men consuming the most diet soda had a 31% increased risk of non-Hodgkin’s lymphoma and a 102% increased risk of multiple myeloma.

-This association was not seen in women.

-Men consuming the most regular soda (not diet) had a 66% increased risk of non-Hodgkin’s lymphoma.

Why You Should Be Concerned

1) This is a very well designed study.  Harvard’s Nurses’ Health Study and Health Professional Follow-up Study are two of the best cohort studies in the whole world. 

2) A recent very large study in rats saw increases in risk of these cancers with a high consumption of aspartame, which is the sweetener used in diet soda.

3) This association is biologically plausible.  Aspartame in liquid breaks down to its 3 ingredients; methanol, aspartic acid, and phenylalanine.  Formaldehyde is metabolized from methanol and is a documented carcinogen.

Why You Should Not Freak Out Entirely

1) There is a lot of previous research on the health effects of aspartame, I mean a lot.  It is arguably the most tested food substance in the history of the world.  The results of this research in both humans and animals is that it is safe.

2) When the cohorts were combined, there was no association between diet soda and these cancers.  Also when women were analyzed separately, there was no association between diet soda and these cancers.

3) The men showing an increased risk of cancer were drinking a lot of diet soda, an average of 11 servings per week.  A serving is considered 12 ounces.  Men with lower consumption, even up to 6 servings per week, saw no increased risk of these cancers.

4) It may not even have been the aspartame that caused the problem.  Because there was an increased risk in non-Hodgkin’s lymphoma in men drinking a lot of regular soda, the researchers theorized that it may be something else in soda in general, perhaps another ingredient common to both diet and regular soda (such as the caramel coloring) or a substance used in the packaging.

5) There is really no reason that there should be a sex difference in risk of cancer with this exposure.  The sex difference in risk combined with the fact that risk was elevated in regular soda drinkers as well means the results could have been due to chance.  In fact, the researchers mention as much in their own conclusions.

Recommendations

As the first study to show harm with high levels of diet soda consumption, this will no doubt spur new research in this field.  We should all keep our eye on it. 

My clients and readers of my books know that I advocate 100% sugar avoidance and, instead, occasional non-nutritive sweetener use twice a week on splurge meals.   It is my opinion that this level of consumption is safe, even after reading this study.  Two or three diet cokes a week have never been shown to cause any problem, including in this investigation.  If you are drinking tons of diet soda every day, is this study enough to make you stop?  It probably would be for me. 

However, my clients and readers of my books already know that daily consumption of diet soda is a bad idea for a number of reasons.  But that is a whole other story and this post is long enough already!

Although this study is the first to suggest a potential negative health effect of diet soda, keep in mind that lots of research has found an association between regular soda and risk of obesity, diabetes, and even heart disease.  Artificial sweeteners, although far from perfect, when consumed in moderation, are still the lesser of two evils.

Before I read this study, I had aspartame in the “occasional use” category.  In other words, I looked at it as I did red meat.  Now and again consumption is not likely to cause a problem, but daily consumption may.  After reading this article and considering all previous literature, I still look at it this way.

One last note: both this study, and the study in rats focused on aspartame, also known as Equal.  Sucralose, also known as Splenda, has not been shown to have any negative health effects.  Therefore, when you do occasionally use an artificial sweetener, it may be a good idea to go for products made with Splenda instead of Equal just to be on the safe side.